Fillable Form 20: 20-2021 INCOME REDUCTION REQUEST (INDEPENDENT) (Mt. San Jacinto Community College District)

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Form 20: 20-2021 INCOME REDUCTION REQUEST (INDEPENDENT) (Mt. San Jacinto Community College District)

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  • 5 check-boxes
  • 70 other fields

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File type: PDF

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2020-2021 Income Reduction Request Page 1 of 2
INREDUC
The Financial Aid Office realizes that some students may have a special circumstance that caused a substantial reduction in their
income that impacts their ability to contribute to college costs.
If you and/or your spouse experienced one of the special circumstances outlined below, you may request re-evaluation of your
financial need based on 2019 income instead of 2018. You may appeal one time only. Complete this form ONLY if your and your
spouse’s financial resources are SUBSTANTIALLY LOWER in 2019 than it was in 2018.
Complete all sections A, B, C, D and attach all requested and supporting documentation. An incomplete appeal will be denied.
A. REASON FOR REQUEST
SPECIAL CIRCUMSTANCE
SUPPORTING DOCUMENTATION REQUIRED
DEATH OF SPOUSE
Your spouse worked in 2018 and their income was reported on the
FAFSA, but is now deceased.
•
Copy of death certificate or equivalent
• Proof of income generated by the deceased individual after
12/31/19
SEPARATION OR DIVORCE
You and your spouse have become separated or divorced since filing
2018 taxes.
•
Copy of the divorce decree, and/or proof of separate
domiciles.
UNEMPLOYMENT OR CHANGE IN EMPLOYMENT
You and/or your spouse earned money in 2018 and have lost this source
of income since filing the FAFSA.
You and/or your spouse worked and are no longer working now, and/or
suffered a reduction in hours or reduced wages.
•
Copy of most recent pay stubs showing YTD earnings for all
jobs held within the last 12 months
• Letter of Unemployment Insurance Claim Information or
other documentation showing unemployment benefits
dates, amount received, and benefits remaining
• Letter from employer (company letterhead) stating the
cause for change in hours or employment status.
DISABILITY
You and/or your spouse experienced difficulty earning income due to an
unanticipated disability in 2019.
•
Proof of disability
• Proof of YTD earnings
LOSS OF BENEFITS OR NON-RECURRING INCOME
You and/or your spouse received income in 2018 (such as inheritance,
early withdrawal of Pension/401K/IRA, Social Security or Child Support)
that is not typical or expected to be received after 12/31/19.
•
Copy of 2018 IRS tax document that reflects the source of
income (IRS form 1040, 1099, etc.)
To request a copy of your *Federal IRS Tax Return Transcript, Wage Statement, OR Verification of Non-Filing Letter
call the IRS at 1-800-908-9946 or go to http://www.irs.gov/individuals/Order-a-Transcript
B. VERIFICATION
In addition to the items requested above for your specific circumstance, please provide each of the following:
ADDITIONAL DOCUMENTATION REQUIRED
1 Detailed letter outlining your or your family’s situation and the impact on your 2019 household’s income
2 2020-2021 Student Income Verification Form Available on our website www.msjc.edu
3 2020-2021 Household Verification Form Available on our website www.msjc.edu
4
2018 Federal IRS Tax Return Transcripts* and all 2018 W-2s
If filed a 2018 Federal Tax Return
2018 Verification of Non-Filing* and all 2018 W-2s (if worked) If did not file a 2018 Federal Tax Return
5
2019 Federal IRS Tax Return Transcripts* and all W-2s
If filed a 2019 Federal Tax Return
2019 Verification of Non-Filing* and all 2019 W-2s (if worked) If did not file a 2019 Federal Tax Return
20
20-2021 INCOME REDUCTION REQUEST (INDEPENDENT)
STUDENT INFORMATION
Please PRINT clearly with black/blue ink
Last Name
First Name
M.I
P R I N T
C L E A R
2020-2021 Income Reduction Request Page 2 of 2
INREDUC
A submission of this appeal form does not guarantee an increase in your financial aid award. The change in your financial
resources must be substantial.
C. 2018 & 2019 YEAR INCOME COMPARISON
Indicate the 2018 & 2019 year income (received from January 1st to December 31st) for you and your spouse (if applicable). Attach
all appropriate documentation to verify your income.
Type of Income
Independent Student
2018 Year Amount
Independent Student
2019 Year Amount
Date
Change Occurred
Student
Spouse
Student
Spouse
Wages, Tips, Salary
Retirement Benefits
Disability Benefits
Unemployment Benefits
Social Security Benefits
TANF/CAL WORKS Benefits
Alimony
Child Support Received
Veteran’s Disability Benefits
Other (specify)
Total Income
D. CE
RTIFICATION
I/WE HEREBY CERTIFY THAT ALL INFORMATION REPORTED ON THIS FORM AND ANY ATTACHMENTS HERETO ARE TRUE, COMPLETE
AND ACCURATE. FALSE INFORMATION OR MISREPRESENTATION WILL BE CAUSE FOR DENIAL, REDUCTION, WITHDRAWAL, AND/OR
REPAYMENT OF FINANCIAL AID.
__________________________________________________________________ _____________________________
Student’s Signature Date
__________________________________________________________________ _____________________________
Spouse’s Signature (Required if applicable) Date
FINANCIAL AID OFFICE USE ONLY
Request Status:
Trans.#:
Denied
Approved (If already awarded, a revised award notification will be issued within 3-4 weeks.) New EFC:
FA Signature: Date:
Comments:
2020
-2021 INCOME REDUCTION REQUEST (INDEPENDENT)
STUDENT INFORMATION
Please PRINT clearly with black/blue ink
Last Name
First Name
M.I
Mt. San Jacinto College Financial Aid Office
Website: https://msjc.edu/financialaid/
Virtual Lobby: https://msjc.edu/hub/
Telephone: (951) 487-3245
Email: Finaid@msjc.edu
C L E A R
P R I N T
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
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Form 20: 20-2021 INCOME REDUCTION REQUEST (INDEPENDENT) (Mt. San Jacinto Community College District)

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Completed 5 September 2020

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